Executive Brief for Healthcare Leaders
In this study, healthcare stands out in one critical area: honest communication. And not in a good way.
Key Findings
Healthcare professionals report significantly lower levels of honest dialogue with senior leadership than nearly every other industry studied.
45.5% cite fear of negative consequences as the primary reason they withhold concerns or feedback.
Healthcare teams struggle more than average with discussing conflict, mental health, and asking for help, the exact conversations that affect patient outcomes and retention.
The consequences show up in morale, recurring errors, increased stress, and disengagement.
This is not a personality issue. It is a leadership and systems issue, and it is fixable.
What If the Nicest Teams Are the Most Broken?
Here's something most healthcare leaders don't want to hear: your team might look healthy on the surface—no drama, no blow-ups, everyone getting along—and still be seriously broken underneath.
We see it all the time. Teams where critical problems go unaddressed, where the same mistakes keep happening, where the best ideas die in someone's head because they didn't feel safe enough to say them out loud. That's not harmony. That's a slow bleed.
We recently sponsored a national study on honest communication across industries—over 1,000 participants. When we pulled the healthcare data, the numbers told a story that should make every healthcare executive sit up and pay attention.
Healthcare teams are more afraid to speak up, feel less heard by leadership, and experience worse personal consequences from silence than workers in nearly every other industry we studied.
This paper lays out exactly what we found, why it matters, and what you can do about it.
The Data
The Numbers Don't Lie
(But Your Team Might)
You'd think people who deal in life-and-death decisions every day would be great at straight talk. The data says otherwise.
of healthcare professionals say they have honest conversations with senior leaders "Always" or "Most of the time."
Across all other industries? That number is 54.7%. Healthcare is a full ten points lower.
Nearly half of healthcare leaders are flying blind, missing warnings, insights, and ideas their own people are holding back.
report honest communication with coworkers or team members—compared to 73.6% in other industries.
This isn't about whether people are polite in the hallway. It's about whether they're sharing the stuff that matters.
In healthcare, that kind of silence has real consequences. The concerns, the observations, the "I noticed something that doesn't seem right"—when those go unsaid, patients and teams pay the price.
The Root Cause
Why Healthcare Teams Keep Their Mouths Shut
This is where it gets uncomfortable. Because the reasons people stay silent aren't mysterious—they're predictable. And in most cases, leadership is creating the conditions for it without realizing it.
of healthcare workers say "fear of negative consequences" stops them from being honest.
That's compared to 38.4% across other industries.
Think about that. Almost half your team is sitting on critical information—patient safety concerns, process improvements, staffing issues—because they're afraid of what happens if they say it out loud. Not because they don't care. Because they've learned it's not safe.
Leadership Isn't Hearing It
35.7% say their leadership "isn't open to feedback or disagreement" (compared to 31.4% elsewhere). And 36.6% report that their feedback is "often ignored or dismissed."
Here's the thing: most leaders we work with would swear their door is always open. And they probably believe it. But there's a massive gap between thinking you're approachable and your team actually experiencing you that way. That's the gap that kills teams.
The "Harmony" Trap
say their workplace "values harmony over honesty"—compared to 24.8% in other industries.
This is the one that catches people off guard. Harmony sounds great. Who doesn't want a harmonious team? But when "harmony" means nobody rocks the boat, nobody challenges a decision, nobody flags a problem—that's not peace. It's a cover story for dysfunction.
At Steven Gaffney Company, we call this the difference between Notice vs. Imagine. When people can't speak honestly, they stop dealing in facts ("I noticed...") and start operating on assumptions ("I imagine they'd react badly if I said..."). That's when teams start breaking down.
The Danger Zones
What They Can't Talk About Is Exactly What Matters
The study asked people which topics are hardest to discuss honestly at work. Healthcare professionals struggled significantly more than people in other industries on the topics that matter most:
Conflict or Disagreement
Mental Health or Emotional Well-Being
Asking for Help
Read that again. Healthcare teams—people whose jobs require collaboration, precision, and trust—are significantly worse at talking about conflict, mental health, and asking for help than the average worker. These aren't minor soft-skill gaps. In healthcare, these are the conversations that directly affect patient outcomes and staff retention.
The Price Tag
What This Silence Is Actually Costing You
The price tag on all this unsaid stuff isn't theoretical. Healthcare workers in the study pointed directly to what happens when honest communication breaks down:
cite "poor team morale and disengagement" as a direct result of lacking honest communication.
vs. 42.2% across all industries
point to "unresolved problems or recurring mistakes."
vs. 45.7% overall
feel "unheard or undervalued"—far exceeding the 33.9% average.
experience "increased stress or anxiety" from lack of honest communication (vs. 31.3% overall).
We've said for years that 80% of all work problems can be traced to a lack of open, honest communication. In healthcare, those problems don't just cost money—they cost well-being, retention, and in the worst cases, patient safety.
The uncomfortable truth? Most healthcare leaders don't see these costs because they're buried in the things nobody is saying.
The Path Forward
How to Fix It: From Silence to Foreshadowing Honesty
The good news: this is fixable. We've worked with organizations across nearly every industry—from Fortune 500 companies to the U.S. military—to close exactly this kind of communication gap. The approach isn't complicated. But it does require leaders to be intentional about four things.
Organizations that have closed this gap do not rely on personality or good intentions. They build repeatable communication systems.
Make It Actually Safe to Speak Up
The number one thing healthcare workers said would make them more honest? "Feeling emotionally safe to speak without judgment" (39.3%). Not more meetings. Not an open-door policy. Actual emotional safety.
That means you don't just say "I want to hear from you." You prove it by how you respond when someone tells you something you don't want to hear. Every time a leader reacts poorly to honest feedback, it teaches the entire team to shut up. Every time a leader handles it well, it opens the door wider.
This is what we mean by Getting the Unsaid Said®. It's not about forcing people to talk. It's about creating conditions where they don't have to be brave to be honest.
Prove That Speaking Up Leads Somewhere
33.9% said they'd be more honest if they believed it would lead to positive change. Another 27.7% said they needed to know their feedback would be taken seriously.
People aren't withholding information to be difficult. They've just done the math: if nothing changes when I speak up, why take the risk? Leaders have to close that loop. When someone shares a concern, follow up. Show them what happened because of their input. That's how you build a team that shares the important stuff before it becomes a crisis.
Build the Skill, Not Just the Intention
Most people want to be more honest at work. They just don't know how to do it without it going sideways. That's a skill gap, not a character flaw.
Teams need practical tools for delivering tough feedback, navigating disagreement, and discussing sensitive topics without it becoming personal. The Team Achievement Accelerator™ is built for exactly this—giving teams a shared framework and common language for the conversations that matter most.
Create Real Pathways for Honest Dialogue
Good intentions aren't enough. You need structure. That means regular, intentional forums where honest conversation is expected—not just tolerated. It means clear processes for raising concerns. And it means leaders who model this behavior consistently, not just when it's convenient.
When you get all four of these working together, something shifts. Teams stop reacting to problems and start anticipating them. We call this Foreshadowing Honesty—the level where teams are so aligned and so open that they see issues coming before they arrive. That's the hallmark of a Consistently High Achieving Team (CHAT)®.
The Bottom Line
If your healthcare team looks calm on the outside, that doesn't mean things are going well. The study makes it clear: healthcare has a bigger honesty problem than most industries—and the costs are showing up in morale, mistakes, burnout, and turnover.
But here's the flip side: every team we've worked with that has committed to Getting the Unsaid Said® has seen measurable change—in trust, in team cohesion, in results.
This isn't about making people more comfortable. It's about building a team where honest communication is the standard, not the exception. Where problems get solved before they become crises. Where people stay because they feel heard.
That's a team worth building.
Ready to Address What's Not Being Said on Your Team?
If this data hits close to home, let's talk. We work with healthcare leadership teams to close the communication gaps that are silently draining results and driving good people out.
Learn more at stevengaffney.com